Medicaid Primary Care Parity

From Health Affairs:

For 2013 and 2014, the federal government raised payment rates to Medicaid primary care providers. Only some states plan to extend the rate increase.

Section 1202 of the Affordable Care Act (ACA) required states to raise
Medicaid primary care payment rates to Medicare levels in 2013 and 2014,
with the federal government paying 100 percent of the increase. This
provision–often referred to as “Medicaid primary care parity” or the
“Medicaid primary care fee bump”–was intended to encourage primary care
physicians to participate in Medicaid, particularly in the face of an
expected increase in enrollment as a result of the ACA’s expansion of
the program.

Federal lawmakers failed to reauthorize the fee bump during the 113th
Congress, ending in December 2014. As a result, states must decide
whether to revert to previous primary care payment levels or continue
at a higher level but without the benefit of the enhanced federal match.
Full details:
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=137

Premiums For 2015 Silver-Level Health Insurance Plans Being Offered at Lower Rates in Many Geographic Areas Than 2014

Consumers in most of the geographic areas studied will be able to obtain 2015 silver-level health plan coverage at lower rates than were available in 2014 or at premium increases of less than 5 percent found a new study by the Urban Institute.

Observers had been concerned that large premium increases might kick in for year two of the ACA health insurance marketplace experience.

Often the researchers found that a different carrier from the 2014 health plan is offering the lowest priced silver option in a rating area for 2015.

The ACA’s incentives, centered on the silver plan premiums in an area, the study report said, resulted in “healthy competition over rates in many markets in 2014, particularly in urban areas. Markets generally saw a large number of competing carriers offering several plans.”

The Urban Institute report said national commercial plans, “particularly Blue Cross Blue Shield (BCBS) plans, as well as local carriers, entered the health insurance marketplaces in 2014.”

Plans previously providing coverage only for Medicaid beneficiaries and cooperatives also entered the marketplaces in a number of areas, the researchers said. “As a result of competition, premiums were surprisingly modest in many areas, particularly in comparison with benchmarks such as small group market premiums.”

The study analyzed non-group marketplace plans. “We focus on 17 states and the District of Columbia, which were the first to complete their rate review and approval processes,” the researchers said.

Overall, the study found that: Continue reading

What They Learned From the First ACA Open Enrollment Period in California

Affordability means different things to different people, target enrollment groups have unique interests and require tailored messaging, partnerships matter and are transformative, and, many consumers are new to insurance and need extensive education about health insurance terminology, are among the lessons learned by officials at the California Health Benefit Exchange called Covered California in a review of its first open enrollment period 2013-2014.

The new report, “Covered California Open Enrollment 2013-2014: Lessons Learned” looks at the experience from the first year California offered expanded health coverage through new Affordable Care Act subsidies and the expansion of Medi-Cal through the Covered California marketplace, the organization said.

More than 3 million state residents were enrolled in coverage during the first enrollment period — 1.4 million in health insurance through Covered California2 and more than 1.9 million in Medi-Cal, officials said.

“The report,” the organization said, “provides the first in-depth review of our efforts in the first year, including marketing, outreach and education, eligibility and enrollment support, consumer profiles, marketing research, and information about those we still need to enroll.”

The populous state faced “outsized challenges, making it unique among states establishing state exchanges. From the start, California focused on addressing these challenges in the design of the marketplace and in the state’s approach to reaching, educating and enrolling millions of uninsured and underinsured Californians, particularly those who struggle to afford the costs of health care and coverage.”

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The National Directory of Physician Organizations Database

Key contacts information on more than 1,370 physician organizations. including: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, management service organizations (MSOs) and primary care networks.

Get details here: The National Directory of Physician Organizations Database

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Covered California said it was also “mindful that its marketplace design and implementation would shape the broader health insurance market in California for those who were not eligible for subsidies through the exchange, many of whom had coverage before the initial open enrollment.”

Some 7.1 million state residents were uninsured, officials said, sometime during the year before implementation of reform.

Among the lessons learned:

* Many consumers are new to insurance and need extensive education about health insurance terminology, how to enroll in coverage and how to use insurance.

* Consumers need clear, straightforward information that explains how insurance works in plain language, without jargon. There is an ongoing need for a comprehensive,accessible, educational campaign to help answer common questions about Covered California’s products and promote the value of insurance. For 2015 open enrollment, advertising messaging is attempting to explain, in first-person testimonials, that health coverage means going to the doctor and getting the care you need.

* Affordability means different things to different people. Many consumers, even with financial assistance through federal subsidies, found cost to be a barrier to obtaining coverage. Future communications need to address the issue of affordability by emphasizing the value of having insurance and the financial security (protection from arge medical bills) that it provides. New advertising and marketing materials include testimonials from newly insured Californians explaining that insurance is a bill they don’t mind paying each month, with an emphasis on the peace of mind of having coverage and the financial security it brings for those able to purchase it.

* Target enrollment groups have unique interests, experiences and perspectives and require tailored messaging and customizable materials. Consumers in different age, income, gender and ethnic groups reflect different circumstances, knowledge and needs for information and support. Media messaging, marketing and collateral materials, assister training, and community outreach and enrollment efforts need to address the specific needs and interests of diverse communities. Community partners, grantees, agents and enrollment counselors need simple, updated fact sheets, fliers, brochures and other materials, including customizable materials for local events and target groups.

Covered California expanded its targeted support to local outreach and has developed, and will continue to develop, customizable, focused materials available to community partners and insurance agents for open enrollment in 2015.

* Most consumers relied on a variety of touch points, including in-person assistance, to successfully complete enrollment. Most consumers needed multiple touch points, whether pursuing self-service or an assistance pathway. They wanted to ask questions, get answers, identify the options and then consider, often in consultation with friends and family, the coverage most suitable for them. Covered California responded by shifting marketing and outreach messaging and encouraging Californians to take advantage of free, confidential, in-person assistance in local communities. More than 6,400 Certified Enrollment Counselors and more than 12,000 Certified Insurance Agents will be part of a comprehensive campaign for enrollment in 2015.

* The multi-channel marketing and media mix struck an effective balance between brand (awareness) and direct response (enrollment) and will continue to be tailored to specific target audiences. The large number of those eligible who enrolled is the strongest indicator that the community-level outreach, marketing and media campaigns, as adjusted in real time, were successful in accomplishing the two program goals: brand awareness and enrollment. Going forward, marketing and advertising will support the community outreach campaign targeting key demographic groups and segments. Building on brand awareness, advertising will be aimed at explaining how to enroll and motivating audiences to enroll by sharing the tangible ways having health coverage is improving the lives of real people.

* Partnerships matter and are transformative. At every stage of planning and implementation for the first open enrollment, Covered California relied on and collaborated with a multicultural and varied set of state and local partners who made the unprecedented effort possible. Covered California partners made real-time adjustments and accommodations as challenges surfaced and consistently helped in resolving and addressing those challenges. The partnerships reaffirm the power of shared commitment, collaboration and common effort.

Following is the link to the report: http://www.coveredca.com/resources/PDFs/10-14-2014-Lessons-Learned-final.pdf

 

 

 

Key Trends Facing Private Practice Physicians in the New Year Identified

Physicians in private practice have their non-clinical work cut out for them in the year ahead. Results of the ACA changes, the launch of the federal and state health insurance market places, demanding paperwork burdens, and coming changes in coding requirements and health IT are all issues facing the physicians in 2014.

Among the key trends that seen to be bearing down on practicing physicians are:

 –  Rapidly increasing medical consolidation seen across health care systems and insurance companies alike.

–   The difficulty physicians experience while trying to negotiate favorable terms with payers because  the total number of health insurers has been decreasing for some time as a result of industry consolidation.

–   Physicians are continuing to struggle with a growing regulatory paper work burden.

In addition the recent launch of the health insurance exchanges is already driving high levels of confusion among patients, physicians and employers.

Coping with minimal education and support on the new health insurance exchanges from the government, many private practice physicians are unsure of how these new insurance policies will affect their practices. Continue reading

Three Additional MCOs Signed For State Medicaid Health Services in KY

Anthem, Humana and Passport have signed agreements with the Cabinet for Health and Family Services to provide healthcare services to state residents who will be newly eligible for coverage under the expansion of Medicaid, a provision of the Affordable Care Act.

The three new MCOs are in addition to Coventry and WellCare, which are currently serving this area, officials said.

Beginning October 1 residents in 104 Kentucky counties who are determined to be newly eligible for Medicaid will be able to choose the health plans as their healthcare provider for coverage effective Jan. 1, 2014.

“Under the terms of the contract, the three MCOs will initially serve exclusively the more than 300,000 who will be newly eligible for Medicaid,” officials said. Continue reading

Tax Credits Estimated to Average $2,700 Per Family Next Year for People Who Now Buy Their Own Insurance

Americans who currently buy their own insurance through the individual market would receive tax credits averaging nearly $2,700 next year for coverage purchased through new insurance marketplaces, found a new study.

The tax credits or subsidies would cover 32 percent of the premiums on average for this group of enrollees in a so-called “silver” plan, according to the Kaiser Family Foundation analysis. .

Foundation researchers released the analysis as some states are releasing information on what premiums will be in 2014 when the Affordable Care Act’s market reforms and newly created health insurance marketplaces take effect.

The rate announcements illustrate “sticker prices” that do not reflect federal subsidies that will offset the cost of insurance for many current individual market policy holders, said the foundation based in Menlo Park, California.

“Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year,” Foundation President and CEO Drew Altman said. “They will help make coverage more affordable for low- and middle-income people.”

Under the ACA tax credits will be available to subsidize premiums for people who buy their insurance in the new marketplaces, do not have access to other affordable coverage, and have incomes between 100 percent and 400 percent of the federal poverty level (between about $11,500 and $46,000 for a single person, and $24,000 and $94,000 for a family of four).

An estimated 48 percent of people who currently have individual market coverage will be eligible for tax credits, researchers found. Tax credits among those eligible will average $5,548 per family, and subsidies will average $2,672 across all families now purchasing their own insurance, the researchers said.

Many people who are now uninsured will also be eligible for subsidies in the new marketplaces, and their tax credits will likely be higher on average since they have lower incomes than those who now buy their own coverage, the researchers said.

Using data from the Congressional Budget Office (CBO) and the federal government’s Survey of Income and Program Participation, study authors said the analysis estimates the average impact of the ACA on the individual market by quantifying how current enrollees will fare once relevant provisions of the health law are implemented.

Premium data released by states thus far suggest that the CBO premium projection is reliable, the researchers said. While subsidies and premiums will vary widely depending on each enrollee’s personal characteristics, the analysis focuses on averages to provide an indication of how much overall assistance the law will provide to people buying their own coverage today, the study authors added.